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Mental Health Nursing > Lecture 9 - Neurocognitive + Peds > Flashcards

Lecture 9 - Neurocognitive + Peds Flashcards

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1
Q

What is cognition?

A

System of interrelated abilities, such as perception, reasoning, judgment, intuition, and memory

Allows one to be aware of oneself

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2
Q

What is memory?

A

Facet of cognition, retaining and recalling past experiences

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3
Q

What is delirium?

A

Acute cognitive impairment caused by medical condition (ex: infection), substance use, or multiple etiologies

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4
Q

What is Dementia in comparison to delirium?

A

Chronic, cognitive impairment

Differentiated by cause, not symptoms

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5
Q

How do we treat delirium?

A

By treating the cause
–> Acute

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6
Q

What is the diagnostic criteria for delirium?

A

Key feature: Impairment in cognition
–> Disturbance in consciousness and a change in cognition
–> Develops over a short period of time
–> Usually reversible if underlying cause identified
–> Serious, should be treated as an emergency (25% of patients do not survive)

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7
Q

How do we assess for delirium?

A

Confusion Assessment Method (CAM)
Acute Onset + Inattention

With one of the following:
–> Disorganized thinking
–> Disturbances in consciousness

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8
Q

What are the behavioural/physical signs associated with delirium?

A

Attention wandering
Perseveration
Easily distracted
Daytime sleepiness
Night-time agitation
Restlessness

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9
Q

What are common causes of delirium?

A

–> Medications
–> UTI/Lung infection (geriatric)
–> Fluid and Electrolyte Imbalance
–> Hypoxia/ischemia

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10
Q

What are the major theories of causative factors for delirium?

A

Reduction in cerebral functioning, white matter, and damage of enzyme systems, the BB-Barrier, or cell membranes.

May also be reduced brain metabolism and imbalance of NTs.

Raised plasma cortisol levels during acute stress

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11
Q

Delirium is more common in which demographics?

A

More common in women
–> Also elderly, postoperative, cancer treatment pts

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12
Q

What is a primary cause of delirium in nursing homes?

A

Communication barriers associated with cognitive impairment and dementia

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13
Q

What will we focus our MSE on for delirium?

A

Must Assess patient baseline for comparison!

Cognition, orientation, logic

Behaviour changes

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14
Q

What two kinds of behavioural changes will be seen in delirium?

A

Hyperkinetic
–> psychomotor hyperactivity, excitability, hallucinations

Hypokinetic
–> lethargic, somnolent, apathetic

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15
Q

When is comes to delirium, what physical exam could determine the underlying cause?

A

Labs + lytes

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16
Q

What is the priority in delirium care?

A
  1. Rule out life threatening illness
  2. VS
  3. May need to stop medications
  4. ADLs + functional needs
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17
Q

What pharmacological interventions might be helpful for delirium caused by alcohol withdrawal?

A

Benzos
–> Associated with alcohol withdrawal delirium

Monitor for changes in MSE, extrapyramidal symptoms, hypoTN

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18
Q

What kind of social interaction can help a person experiencing delirium?

A

Short, frequent interactions
–> Orient them
–> Lower stimulation from environment
–> Provide sensory aids (if indicated)

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19
Q

What are the initial manifestations of dementia?

A

Possible loss of memory

Possible alteration of short term memory – acquisition of new knowledge

Loss of initiative and interest

Geographical disorientation

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20
Q

What are the S/S of intermediate dementia?

A

Difficulties recognizing loved ones
Behavioural changes (wandering, agitation, etc.)

Loss of long term memory and loss of procedural memory

Confusion and insomnia

Aphasia (knowing what to say, not finding words to say it)

Apraxia (Inability to execute movement)

Agnosia (inability to identify objects)
Hallucination, delusions & illusions

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21
Q

What are the S/S of advanced dementia?

A

Incapacity to assimilate new information

Incomprehension of words

Dysphagia

Immobility

Incontinence

Echolalia

Dependent for ADLs

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22
Q

How did the diagnostic criteria for initial dementia change in the most recent DSM?

A

Previously was memory loss, is now diffuse symptoms and geographical disorientation

23
Q

What are the different causes of dementia?

A

Alzheimer’s (most common)
Vascular
HIV related
Related to trauma

Related to Parkinson’s, Huntington’s chorea’s, Creutzfeldt-Jacob, etc.

Frontotemporal dementia (memory loss is secondary to behavior alterations)

Persistent substance use (hallucinogens, alcohol, etc.)

24
Q

What are the most likely causes of Alzheimer’s type dementia?

A

Beta-Amyloid Plaques

Neurofibrillary Tangles

Cell Death and Slowed Neurotransmission

Genetic Factors

Inflammation involved - unsure if cause or effect

25
Q

How to treat dementia?

A

Establish a baseline in functional sphere to track disease progression

Manage cognitive symptoms and aim to delay cognitive decline

Treat non-cognitive symptoms - psychosis, mood symptoms, and agitation

Support caregivers!

26
Q

What are the priority physical assessments in someone with dementia?

A

Self-Care
Sleep-Wake Disturbances
Activity and Exercise
Nutrition
Pain

27
Q

In which stage of dementia are mood changes such as depression anxiety be more common?

A

Intermediate

28
Q

What behavioural changes might be seen in dementia?

A

Apathy & Withdrawal

Aggression

Aberrant motor behaviour

Disinhibition + hypersexuality

Catastrophic reactions to everyday situations

29
Q

What pharmacological interventions can be used for dementia?

A

AChEI like Donepezil
–> Alzheimer’s only

Antipsychotics
–> Symptom management

Antidepressants + Mood Stabilize + Anxiolytics
–> Symptom management

30
Q

Why should you be careful when giving someone with dementia an antianxiety medication?

A

Paradoxical Reactions are a possibility
–> Causes increase anxiety

31
Q

For people with dementia, we should avoid medication with anticholinergic effects?

A

We need to increase cholinergic responses between the neurons

32
Q

What interventions can be helpful for those with dementia?

A

Validation therapy
Memory Enhancement
Maintenance of Language Function
Supporting Visuospatial Functioning

33
Q

Should you reason with illusions and delusions in dementia?

A

Not likely to be effective
–> Redirect

34
Q

Most children will develop ____ when experiencing stressors

A

Most develop “normally” despite them.

35
Q

What is the diagnostic criteria for ADHD?

A

Inattention, hyperactivity and impulsivity that are present in at least two settings (school, home, friends)

36
Q

How do stressors in childhood contribute to issues in adulthood?

A

Stressors might contribute to a reduced ability to develop adaptive coping mechanisms and strong interpersonal relationships

37
Q

What are diagnostic criteria for ASD?

A

Impairment in communication + imagination/creativity

Impairment in social interactions

Restricted and/or stereotypical pattern of behaviours/interests

Ranges from mild, moderate, and severe.

38
Q

What is ODD?

A

Negative, disobedient, hostile, and defiant behaviour toward authority. Severity related to number of setting where behaviours are observed.

Does not violate basic rights of others.

39
Q

What is conduct disorder? What are the four types?

A

Pattern of antisocial behaviour that violates the basic rights of others and disregards social norms
–> Aggression, property destuction, theft, rule violation

40
Q

What is the difference between conduct disorder and ODD?

A

Conduct disorder violates the rights of others and has disregard for social norms - often transitions into ADPD, delinquency/criminality

41
Q

What is separation anxiety disorder?

A

After a child goes through a significant stress they may have altered social, academic or occupational functioning when separated from caregiver

S/S: Fear of being alone, sleeping alone, fear that parental figures will be harmed, somatic symptoms of anxiety.

42
Q

How does GAD present differently in children?

A

Same as adults with an omnipresent feeling of worry
–> Need additional reassurance about all performances.

43
Q

What differences in assessment and interventions differ between children and adults?

A

Must include parents or use them of source of information, and must consider the child’s developmental stage and capacity.

44
Q

Pharmacotherapy in children is a….

A

Last resort

45
Q

Why is dance and art therapy helpful for children?

A

Allows children to experience emotions in a social setting in a safe environment
–> Realigns with feelings of safety

46
Q

What is the political role of nurses in mental illness in a pediatric environment?

A

To deconstruct the way society thinks about childhood mental illnesses and to promote advocacy.

47
Q

What are beta-amyloid plaques and how to they affect the brain?

A

Cause of Alzheimer’s
–> Deposits that destroy cholinergic neurons

48
Q

What are neurofibrillary tangles and how do they affect the brain?

A

Cause of Alzheimer’s
–> Exist in limbic system and contribute to memory disturbances

49
Q

What chromosomes are involved in Cause of Alzheimer’s?

A

1, 14, 21

50
Q

How does dementia with Lewy bodies present?

A

With fluctuating cognitive and early changes in attention and execute dysfunction
–> Parkinsonian features

51
Q

What causes vascular dementia?

A

One or more cerebrovascular events

52
Q

What kind of dementia has insidious and rapid onset with rapid progression of impairment and is rapidly fatal?

A

Prion

53
Q

What medications should you avoid with dementia patients?

A

Those with anticholinergic effects
–> Like codeine

Mental Health Nursing (18 decks)

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